Reversal of Lamina Cribrosa Displacement after Intraocular Pressure Reduction in Open-Angle Glaucoma

doi:10.1016/j.ophtha.2012.08.047

Ophthalmology

Volume 120, Issue 3, March 2013, Pages 553-559

https://doi.org/10.1016/j.ophtha.2012.08.047 Get rights and content

Purpose

To compare the change in lamina cribrosa (LC) displacement in response to intraocular pressure (IOP) lowering in patients with open-angle glaucoma (OAG) using spectral-domain optical coherence tomography (SD-OCT).

Design

Observational case series.

Participants

One hundred eyes of 100 patients with OAG in whom IOP at the follow-up examination had decreased by at least 20% compared with the baseline IOP.

Methods

Serial horizontal B-scan images of the optic nerve head (ONH) were obtained from each eye using enhanced depth imaging SD-OCT. Approximately 65 B-scans covering the optic discs were obtained before and 3 to 6 months after lowering IOP. The baseline and follow-up LC depths (the distance from the Bruch's membrane opening plane to the level of the anterior LC surface) were measured in B-scan images from each eye.

Main Outcome Measures

The mean and maximum amount of reductions in LC depth measured in the 7 selected B-scan images.

Results

Intraocular pressure decreased from 21.2±9.1 to 10.5±2.6 mmHg. The percent of IOP reduction was significantly related to the untreated IOP (P < 0.001). There was a significant decrease in the LC depth at the follow-up examination compared with the baseline value (P < 0.001). The magnitude of LC depth reduction was significantly associated with younger age, higher untreated IOP, higher baseline IOP, and greater percent of IOP reduction (all P < 0.02).

Conclusions

Reversal of the LC displacement was observed after IOP-lowering treatment in OAG. The degree of LC displacement reversal was related to the amount of IOP lowering.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Materials and Methods

This study was approved by the Seoul National University Bundang Hospital Institutional Review Board and conformed to the Declaration of Helsinki.

Results

Of the 130 patients with POAG who were initially enrolled, 17 were excluded because of an IOP reduction of <20% (n = 15) or an extremely low IOPf (5 mmHg, n = 2), which may have resulted in measurement error because of the decreased axial length and change in the corneal curvature. A further 13 subjects were excluded because of poor scan image quality (>5 missing sections of an average of 65 sections). The LC, especially its anterior surface, was readily discernible in most of the B-scans at

Discussion

In this study, we observed a reversal in LC depth with IOP-lowering in eyes with OAG. The degree of reversal of the LC was related to age, untreated IOP, baseline IOP, and amount of IOP lowering.

The magnitude of reduction of LC depth was significantly less in eyes with lower untreated IOP than in eyes with higher IOP. We speculate that this finding is mainly attributable to less IOP reduction in patients with lower IOP than in patients with higher IOP. Alternatively, one may argue that the LC

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: Manuscript no. 2012-594.

: Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. RNW has received instruments from Heidelberg Engineering for use in research.

: Supported by National Research Foundation of Korea Grant funded by Korean Government (2010-0004210) and an unrestricted grant to the University of California San Diego Department of Ophthalmology from Research to Prevent Blindness, New York, New York. The funding organization had no role in the design or conduct of this research.

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Original articleReversal of Lamina Cribrosa Displacement after Intraocular Pressure Reduction in Open-Angle Glaucoma

Purpose

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Financial Disclosure(s)

Section snippets

Materials and Methods

Results

Discussion

Ophthalmology

Prog Retin Eye Res

Am J Ophthalmol

Exp Eye Res

Comparison of glaucomatous progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures

Am J Ophthalmol

The Advanced Glaucoma Intervention Study (AGIS): 7The relationship between control of intraocular pressure and visual field deterioration

Am J Ophthalmol

The effectiveness of intraocular pressure reduction in the treatment of normal-tension glaucoma

Am J Ophthalmol

Original article
Reversal of Lamina Cribrosa Displacement after Intraocular Pressure Reduction in Open-Angle Glaucoma